Muscle-Sparing Latissimus Dorsi Reconstruction - Should this be an index procedure for the modern breast surgeon?A Comparative Study of Standard versus Muscle-Sparing Technique
Association of Breast Surgery ePoster Library. Bathla S. 05/15/17; 166326; P106
Ms. Sonia Bathla
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Abstract
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Introduction
Standard Latissimus Dorsi (SLD) flap breast reconstruction is declining in popularity due to its risks of shoulder dysfunction and donor site morbidity. A muscle sparing (MSLD) technique harvests only a segment of muscle on the anterior thoracodorsal branch, giving potential advantage of less donor site morbidity and less functional disturbance. Data supporting this is limited.
Methods
A retrospective audit was undertaken of all LD reconstructions in a single unit from 2012-2016, including SLD and MSLD. Data was collected pertaining to demographics, hand dominance, side of surgery, length of surgery, and post-operative complications. Patients completed a Quick DASH questionnaire to assess upper limb dysfunction post reconstruction. Mann-Whitney U and Fishers exact tests were used to compare the 2 groups.
Results
34 reconstructions were reviewed, 7 SLD and 27 MSLD. There was no significant difference in median length of surgery between the 2 groups (299 (126-450) SLD, 300 (126-343) MSLD; p=0.75), or complications of seroma, infection and skin necrosis. Quick DASH scores were complete on 70.5% of patients, and were significantly lower in the MSLD compared to SLD group (3.4 (0-11.4) vs 12.5 (0-72.7) (p=0.03)).
Conclusions
MSLD is a good reconstructive option as an autologous flap that has complications similar to SLD, and does not take longer to perform. It appears to have a significant functional advantage over SLD. In an era where resources are limited, it can be used safely and time efficiently in a DGH, especially where microvascular flaps are not suitable or available.
Standard Latissimus Dorsi (SLD) flap breast reconstruction is declining in popularity due to its risks of shoulder dysfunction and donor site morbidity. A muscle sparing (MSLD) technique harvests only a segment of muscle on the anterior thoracodorsal branch, giving potential advantage of less donor site morbidity and less functional disturbance. Data supporting this is limited.
Methods
A retrospective audit was undertaken of all LD reconstructions in a single unit from 2012-2016, including SLD and MSLD. Data was collected pertaining to demographics, hand dominance, side of surgery, length of surgery, and post-operative complications. Patients completed a Quick DASH questionnaire to assess upper limb dysfunction post reconstruction. Mann-Whitney U and Fishers exact tests were used to compare the 2 groups.
Results
34 reconstructions were reviewed, 7 SLD and 27 MSLD. There was no significant difference in median length of surgery between the 2 groups (299 (126-450) SLD, 300 (126-343) MSLD; p=0.75), or complications of seroma, infection and skin necrosis. Quick DASH scores were complete on 70.5% of patients, and were significantly lower in the MSLD compared to SLD group (3.4 (0-11.4) vs 12.5 (0-72.7) (p=0.03)).
Conclusions
MSLD is a good reconstructive option as an autologous flap that has complications similar to SLD, and does not take longer to perform. It appears to have a significant functional advantage over SLD. In an era where resources are limited, it can be used safely and time efficiently in a DGH, especially where microvascular flaps are not suitable or available.
Introduction
Standard Latissimus Dorsi (SLD) flap breast reconstruction is declining in popularity due to its risks of shoulder dysfunction and donor site morbidity. A muscle sparing (MSLD) technique harvests only a segment of muscle on the anterior thoracodorsal branch, giving potential advantage of less donor site morbidity and less functional disturbance. Data supporting this is limited.
Methods
A retrospective audit was undertaken of all LD reconstructions in a single unit from 2012-2016, including SLD and MSLD. Data was collected pertaining to demographics, hand dominance, side of surgery, length of surgery, and post-operative complications. Patients completed a Quick DASH questionnaire to assess upper limb dysfunction post reconstruction. Mann-Whitney U and Fishers exact tests were used to compare the 2 groups.
Results
34 reconstructions were reviewed, 7 SLD and 27 MSLD. There was no significant difference in median length of surgery between the 2 groups (299 (126-450) SLD, 300 (126-343) MSLD; p=0.75), or complications of seroma, infection and skin necrosis. Quick DASH scores were complete on 70.5% of patients, and were significantly lower in the MSLD compared to SLD group (3.4 (0-11.4) vs 12.5 (0-72.7) (p=0.03)).
Conclusions
MSLD is a good reconstructive option as an autologous flap that has complications similar to SLD, and does not take longer to perform. It appears to have a significant functional advantage over SLD. In an era where resources are limited, it can be used safely and time efficiently in a DGH, especially where microvascular flaps are not suitable or available.
Standard Latissimus Dorsi (SLD) flap breast reconstruction is declining in popularity due to its risks of shoulder dysfunction and donor site morbidity. A muscle sparing (MSLD) technique harvests only a segment of muscle on the anterior thoracodorsal branch, giving potential advantage of less donor site morbidity and less functional disturbance. Data supporting this is limited.
Methods
A retrospective audit was undertaken of all LD reconstructions in a single unit from 2012-2016, including SLD and MSLD. Data was collected pertaining to demographics, hand dominance, side of surgery, length of surgery, and post-operative complications. Patients completed a Quick DASH questionnaire to assess upper limb dysfunction post reconstruction. Mann-Whitney U and Fishers exact tests were used to compare the 2 groups.
Results
34 reconstructions were reviewed, 7 SLD and 27 MSLD. There was no significant difference in median length of surgery between the 2 groups (299 (126-450) SLD, 300 (126-343) MSLD; p=0.75), or complications of seroma, infection and skin necrosis. Quick DASH scores were complete on 70.5% of patients, and were significantly lower in the MSLD compared to SLD group (3.4 (0-11.4) vs 12.5 (0-72.7) (p=0.03)).
Conclusions
MSLD is a good reconstructive option as an autologous flap that has complications similar to SLD, and does not take longer to perform. It appears to have a significant functional advantage over SLD. In an era where resources are limited, it can be used safely and time efficiently in a DGH, especially where microvascular flaps are not suitable or available.
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